**** ********* **, *******, ** *****
407-***-**** **************@*****.*** My LinkedIn Profile
Healthcare Administrator
Versatile and solutions-oriented management professional with over 9 years of extensive experience that includes administration in healthcare and corporate environments. Proven ability to integrate clinical quality and service quality into all aspects of operations and establish a balanced scorecard to monitor and evaluate progress and outcomes. Demonstrated leadership of diverse management teams focusing on aligning program goals to the mission, values, culture and strategic goals of an organization. Solid record of conducting thorough investigations and developing detailed reports to facilitate strategic decision making.
Areas of Expertise:
Healthcare Administration Claims Processing Medicare & Medicaid Regulations Third Party Reimbursement Financial/Revenue Enhancement Office Operations & Administration Team Leadership Resource Allocation Customer Service Analytical Researcher Strategic Thinker Planner Multiple Phone Lines Analytic Skills
PROFESSIONAL EXPERIENCE
Advent Health, Maitland, FL Jan 2021 – Present
Account Representative II – Billing/Collections/Denials
Performs outgoing call to patients insurance to obtain necessary information for accurate billing, collections and correction of denials
Resolves and resubmits rejected claims appropriately as necessary
Process daily and special reports, unlisted invoices and letters, error logs, stalled reports and aging.
Reviews previous accounts documentation, determining appropriate action(s) necessary to resolve each assigned account.
Checking claim status as well as obtaining additional information that is being requested from insurance companies.
Adheres to Central Florida Division South Corporate Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies etc.
NuQuest, Longwood, FL Jan 2017 – Oct 2020
Conditional Payment Coordinator
Provide Conditional Payment Claim (Workers comp) investigation and negotiation services to assist customers in addressing this important MSP compliance obligation
Support attorneys and insurance carriers to provide education and status updates on open files
Interact with regularly with The Benefits Coordination & Recover Center, a government contractor working on behalf of the Center for Medicare Services
Communicate with Medicare to obtain conditional payment estimates, CMS approval status, demands and results of negotiation, and provides Referral Source with updates
ProStaff Agency, Orlando, FL Jul 2016 – Sep 2016
Insurance Reimbursement
Managed hospital billing for Medicaid HMO plans
Examined denials and troubleshooting problems of the claims
Maintained security procedures and confidentially to protect patients right to privacy
Reviewed patient’s files, daily billing reports, assign codes to each given service, and keep up with the submission dates
Examined for Medicaid guidelines compliance and completion before they are submitted
Accessed insurance payments on the web, balance accounts receivable and payable, and deposit funds in the appropriate account
UF Health Cancer Center At Orlando Health, Orlando, FL Jan 2014 – Jun 2016
Sr. Front Office Assistant/Patient Access Specialist (Authorization)
Scheduled patients for diagnostic test (CT scan, Ultrasound’s, Mammogram’s, Echo’s and Bone Scan etc). Check in/out patients and maintaining patient registration
Served as a liaison between the doctor’s offices and answering multiple telephone line and working with the doctor’s one on one
Triaged calls and concerns to the appropriate personnel; scheduled clinic and ancillary appointments as necessary, and provided an atmosphere of genuine concern for patients
Faxed and filed correspondence and adhered to compliance with JCAHO.
Granted authorization for chemotherapy patients and served as a liaison between physicians, patient, and insurances
Interviewed new team members and organized training sessions
Piedmont Heart Institute, Atlanta, GA Nov 2011 – Aug 2013
Patient Access Specialist/Scheduler II
Retrieved new patient’s medical records for 26 of Piedmont doctors.
Called doctors’ offices and hospital to retrieve medical records and uploaded them into EMR, EHR system
Scheduled nuclear stress test, PFT's, echo's, and vascular procedures
Maintained patient registration (new & established) and worked with Citrix, EHR, EMR, and Epic
Trained front office staff on Epic (Super user) with scheduling and registration
Suggested an innovative was of handling errors to keep scheduling running smooth
Assisted with some template building for the doctors
Provided excellent and professional customer service by greeting, answering patient questions via face to face and telephone communications
Scheduled clinic and ancillary appointments as necessary, and provided an atmosphere of genuine concern for our patients. Stay in compliance with JCAHO/OSHA
MEDICAL MANAGEMENT PROFESSIONAL, INC. (MMP), Gainesville, GA Jun 2008 – Nov 2011
Medicaid Biller/Deposit Prep
Submitted claims to Medicaid & Medicare and other major insurance companies that include but are not limited to: Blue Cross Blue Shield, CIGNA, & etc. Examining denials and troubleshooting problems of the claims
Maintained security procedures and confidentially to protect patients right to privacy
Examined for Medicaid guidelines compliance and completion before they are submitted.
Submitted claims in a timely manner to get payments quickly
Reviewed daily billing reports and keep up with the submission dates
Accessed insurance payments on the web, balance accounts receivable and payable, and deposit funds in the appropriate account
Florida Cardiology, Oviedo, FL Medical Assistant May 2007 – Apr 2008
Florida Physician Medical Group, Winter Park, FL Medical Assistant/Front Office Jan 2004 – Apr 2007
Orlando Pulmonary, Orlando, FL Medical Assistant Jul 2002 – Jun 2003
Orange County Official Records, Orlando, FL Document Verification Nov 2000 – Apr 2002
EDUCATION
University of Phoenix- Bachelor of Science - Health Care Administration, June 2011
Career Training Institute - Diploma-Medical Assistant, Jul 2001 – Sept 2002
Jones High School - High School Diploma, May 1999
PROFESSIONAL TRAINING
International Classification of Diseases (ICD-10) Training, Gainesville, GA (Feb 2011)
TECHNICAL SKILLS
Microsoft Office Software (Word Processing)/E-mail
Copiers/Scanners/Typing/Ten Key
EMR/EHR/Epic (Super User)/NexGen/Sunrise/Clinic/CPA etc
TALISHA REDDING